Prescribing to Deprescribing
I love the topic of deprescribing! Like myself, many clinicians consider this to be an essential component of judicious practice. In addition to all the various elements I consider when prescribing a medication, I have now added another: likelihood of future discontinuation.
As clinicians, we are all aware of the potential for side effects or interactions when prescribing, and in fact, the prevalence of drug-related admissions is averaged to be 15.4% (Ayalew et al., 2019). Discontinuing an unnecessary medication has countless benefits for the patient and our health care system! Therefore, it only makes sense that we would incorporate this act into our daily routine.
What is the Act of Deprescribing?
Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit– backing off when doses are too high, or stopping medications that are no longer needed. The goal of deprescribing is to reduce medication burden and maintain or improve quality of life.(deprescribing.org)
Optimizing Patient Outcomes & Satisfaction With Deprescribing
There is absolutely a time and place for prescription medications, but I lean away from immediately prescribing something. First, I prefer to focus on the root cause of each patient’s ailment and lifestyle interventions. For instance, can I get a patient off their T2DM med by REALLY coaching and driving a lifestyle change in a meaningful and connected way? You bet! It’s incredibly empowering and encouraging for patients to hear, “you have done such an amazing job of improving your health that we can stop this medication.”
Patient Impact of Deprescribing
The patient experience will be enhanced because they will:
- Spend less money and less time picking up medications
- Avoid battling with insurance
- Reduce the experience of side effects
- Spend less time organizing pills/schedules- more time for a balanced life
As with many things in medicine, once you get the ball rolling in a positive direction it is intrinsically motivating for the patient.
Adding Deprescribing to Your Practice
So, why isn’t this routinely done?! Clinicians are busy! How can we reasonably spend 10 minutes on medication reconciliation when we have 15 minutes for an appointment? This becomes even more complicated when patients don’t remember their medications and don't provide a list. First, knowing is half the battle. Make it standard in your practice that every patient brings a medication list to their appointment. Delegate and enlist your support staff to routinely update medications. Then, start the process of reconciliation and look for potentially inappropriate medications.
You May Be Interested in More From This Author: 9 Tips to Increase Efficiency in Practice
Identifying Potentially Inappropriate Medications
How do we identify a potentially inappropriate medication? First, consider your patient. We need to be particularly mindful of the elderly, vulnerable and patients on multiple medications. Identify those with multimorbid conditions, disabilities, dementia, limited life expectancy, renal impairment, or multiple prescribers (without collaboration). In general, some medications that may be on your radar to deprescribe include: PPIs, NSAIDS, pain medications, statins, benzodiazepines, sleeping medications, glucose lowering medications, anticholinergics, antidepressants, antihypertensives, and medications on the Beers List (Endsley, 2018; Steinman & Reeve, 2021).
Enacting Deprescribing in Practice
As with all things, it is nice to have a guideline to help us out (UpToDate, AAFP and Deprescribing.org provide a starting point and resources). My goal is to get you actively thinking about and considering this process as part of your regular practice. Commit yourself to regularly reviewing medications and identifying potentially inappropriate prescriptions. It can be time consuming, especially at first, but we owe it to our patients and our healthcare community. You may prevent a hospital visit – and even keep a bed available for someone else who needs it. Most patients would like to take fewer medications; however, they rely on their clinician to start the conversation.
Good luck! Your patients and colleagues will appreciate your diligence!
Stay Up to Date on Important Patient Care Best Practices
It is important for clinicians to maintaining a pulse on new trends in practice or emerging best practices to provide optimal patient care. However, with what time? ThriveAP makes it simple for providers’ to build confidence in a supportive, engaging environment through transition to practice CME/CE curriculums. Each curriculum includes:
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Learn more about how ThriveAP helps clinicians thrive in practice by checking out our primary care and acute care transition to practice curriculums.
Ayalew, M.B., Tegegn, H.G., & Abdela, O.A. (2019). Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures. Bull Emerg Trauma. Oct;7(4):339-346.
Deprescribing Guidelines and Algorithms. Retrieved December 15, 2022 from the World Wide Web: https://deprescribing.org/resources/deprescribing-guidelines-algorithms/
Endsley, Scott (2018). Deprescribing Unnecessary Medications: A Four-Part Process. Retrieved December 15, 2022 from the World Wide Web: https://www.aafp.org/pubs/fpm/issues/2018/0500/p28.html#:~:text=Drug%20classes%20such%20as%20anti,are%20common%20targets%20of%20deprescribing.
Steinman, M., & Reeve, E. Deprescribing. In: UpToDate. Updated 4/2021. Accessed on December 15, 2022.
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